Farid Ahmed is the Editor and Publisher of The Doctor’s Choice, a specialised magazine on health, population and nutrition sector.

Ahmed answered questions on budget allocation for health sector as Bangladesh proposed biggest-ever national budget in parliament o June 1.

The proposed allocations for 2017-18 financial year are being debated and expected to passed at the end of the month.

Following is the excerpt from Ahmed’s interview:

Question: How will you evaluate the proposed budget as a whole?

Ahmed: In financial year (FY) 2017-18, total amount allocated to the health sector is Tk. 2,06.79 billion. The proposed allocation for health sector in FY 2017-18 is 5.2 percent of total budget.

Bangladesh; development budget for 2017-18

In FY 2016-17 and FY 2015-16, the total amount allocated to this sector was Tk. 174.86 billion and Tk. 127.25 billion respectively. The proposed allocation in health sector for FY 2016-17 was 5.1 percent of the proposed budget while it was 4.3 percent of the proposed budget in FY 2015-16.

However, this allocation for health in terms of percentage of total budget may pose challenges to providing adequate health facility to the population as the doctor-population, doctor-nurse, nurse-population ratios are still far away from acceptable levels. As a consequence, the provision of health services to society may remain inadequate. Now the point is that the World Health Organisation (WHO) recommends the allocation should be 15 per cent of the total budget, which Bangladesh’s health sector has never received. And more important point is efficient spending with the pace of increase in allocation as the government’s National Health Account 2011 states that high healthcare costs yearly push 4 to 5 million Bangladeshis into poverty while many fail to avail it. So what we see now is that the allocation for the health sector still remains below 1.0% as share of GDP while the actual expenditure is rather low (0.7% in FY16). We are nowhere near to 5.0% of the GDP for allocation to the health sector as recommended by the WHO and no sign in sight as yet to see that in the near future.

Question: What are the major highlights of the proposed budget in the sector?

Ahmed: I am sure you know that the Government has started new phase of the Health, Nutrition and Population Sector Programme recently to ensure quality and easily accessible healthcare and family welfare services for all the people. This has been rolled out this year to be implemented in the next 5 years at a cost of Tk. 434.86 billion. So this is the first budget after the mega plan has been rolled out.

In order to make healthcare readily available in the rural areas, the Government has 13,339 community clinics. Maternal Health Voucher scheme for poor, vulnerable and critically pregnant women has been introduced in community clinics of 53 upazilas. Besides, emergency pregnancy support service has been strengthened in 132 upazilas.

All districts and 418 upazilas have been brought under mobile phone healthcare services. As many as 43 hospitals have been brought under telemedicine service. A round the clock call center named “Shastho Batayan”(Health Window) has been launched which is providing 24 hour health advice free of cost to the people. Through this programme, the Government has been implementing initiatives for improved healthcare services for mother and child, population control and quality reproductive health services, specialized healthcare services, control of contagious and non-contagious diseases as well as new diseases caused by climate change, safe food with balanced nutrition and human resources development.

In addition, the Government has planned to set up new community clinics and extended maternal health voucher programme in order to take healthcare services to the doorsteps of rural poor and marginalized people. In addition to existing 13,339 community clinics, the Government has planned to establish another 392 community clinics. Forty three telemedicine centres have already been established. Initiatives to provide telemedicine services at district and upazila levels, social health protection programme and health services through video conferencing will continue as well. In these clinics, special care will be provided to the physically challenged persons. So, these are the initiatives highlighted in the budget as well.

Question: Will it be easy to implement these plans?

Ahmed: Not at all! There are shortage of health personnel. There are 5.5 doctors and 2.1 nurses for every 10,000 people whereas the WHO recommends the figures to be 10 and 30 respectively. There are also burden of non-communicable diseases, including cancer, heart diseases and diabetes, and the lack of urban primary healthcare facilities, especially for the poor, and these should be urgently addressed. The WHO says non-communicable diseases account for 59 per cent of deaths in Bangladesh, which is quite high! And the situation is worse in upazila and district hospitals where government doctors often shirk responsibilities. At some places, you will see them overburdened. So, it’s very challenging scenario. I think strengthening the government’s Essential Service Package by ensuring that all get access to essential primary healthcare, like drugs and screening facilities for blood sugar and pressure and cancer, at unions and upazillas will be no less challenging. Many people in Bangladesh suffer from chronic illness and providing medicine to those patients to lessen financial hardships will be great challenge.

Question: What is the scenario in the urban areas? Is it better than the rural areas?

Ahmed: Quite complex and more severe, in fact! Recently, a study was conducted by a research organisation in which 71.3% of the urban population said the quality of healthcare was poor and 56.4% felt that not enough doctors or facilities were available. Frankly speaking, healthcare is fast becoming a major concern for the growing urban population as many in Dhaka find themselves unable to afford the increasing costs of treatments. The study conducted by the Power and Participation Research Centre (PPRC) found that 81% of the city’s population felt that the cost of available medical care was too high for them to bear. This is not only an issue of affordability. The quality is also a major concern and I strongly believe the public representatives cannot avoid the responsibilities for the healthcare sector and lack of quality healthcare in the urban areas. The PPRC study found that 46.1% respondents were uncomfortable to go to hospitals for checkups because of the doctors’ bad conduct. If you go to the Bangabandhu Sheikh Mujib Medical University (BSMMU) early in the morning, you will find thousands of people queuing up for services. The same scenario you will find in the Dhaka Medical College Hospital as well. In fact, these are tertiary level hospitals and lack of proper primary health care facilities in the urban areas made it difficult for these hospitals to serve in a better way. They find it really hard to offer quality services just because they are burdened with pressure.